MEDICARE: JULIE ANN O'BRIEN-SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146.004365	IL

General Provider Information

NPI Number	:	1881113611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANN O'BRIEN-SMITH

Provider Business Mailing Address
First Line	:	1513 26TH ST
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-1382
Country	:	US
Telephone Number	:	815-223-2544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 BOYCE MEMORIAL DR
Second Line	:
City	:	OTTAWA
State	:	IL
Zip	:	61350-2500
Country	:	US
Telephone Number	:	815-433-6433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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Directions to “ JULIE ANN O'BRIEN-SMITH ” Practice Location

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